Feasibility and Effectiveness of Intervention Programmes Integrating Functional Exercise into Daily Life of Older Adults: A Systematic Review

Abstract

Background: Traditionally, exercise programmes for improving functional performance and reducing falls are organised as structured sessions. An alternative approach of integrating functional exercises into everyday tasks has emerged in recent years. Objectives: Summarising the current evidence for the feasibility and effectiveness of interventions integrating functional exercise into daily life. Methods: A systematic literature search was conducted including articles based on the following criteria: (1) individuals ≥60 years; (2) intervention studies of randomised controlled trials (RCTs) and non-randomised studies (NRS); (3) using a lifestyle-integrated approach; (4) using functional exercises to improve strength, balance, or physical functioning; and (5) reporting outcomes on feasibility and/or effectiveness. Methodological quality of RCTs was evaluated using the PEDro scale. Results: Of 4,415 articles identified from 6 databases, 14 (6 RCTs) met the inclusion criteria. RCT quality was moderate to good. Intervention concepts included (1) the Lifestyle-integrated Functional Exercise (LiFE) programme integrating exercises into everyday activities and (2) combined programmes using integrated and structured training. Three RCTs evaluated LiFE in community dwellers and reported significantly improved balance, strength, and functional performance compared with controls receiving either no intervention, or low-intensity exercise, or structured exercise. Two of these RCTs reported a significant reduction in fall rate compared with controls receiving either no intervention or low-intensity exercise. Three RCTs compared combined programmes with usual care in institutionalised settings and reported improvements for some (balance, functional performance), but not all (strength, falls) outcomes. NRS showed behavioural change related to LiFE and feasibility in more impaired populations. One NRS comparing a combined home-based programme to a gym-based programme reported greater sustainability of effects in the combined programme. Conclusions: This review provides evidence for the effectiveness of integrated training for improving motor performances in older adults. Single studies suggest advantages of integrated compared with structured training. Combined programmes are positively evaluated in institutionalised settings, while little evidence exists in other populations. In summary, the approach of integrating functional exercise into daily life represents a promising alternative or complement to structured exercise programmes. However, more RCTs are needed to evaluate this concept in different target populations and the potential for inducing behavioural change.

The Adapted Lifestyle-Integrated Functional Exercise Program for Preventing Functional Decline in Young Seniors: Development and Initial Evaluation

“…Paperwork related to LiFE has been previously discussed as challenging [11], although it is important for behavioral change. Our study participants were asked to ensure they recorded activities accurately, and adherence documentation was collected by trainers during each home visit; this was seen as an additional burden by some participants.…”

“…We know that goal setting and personalized feedback are motivational for older adults, including those in this age bracket [23]. The habit formation concept has been shown to be feasible and effective in previous interventions such as changing dietary behavior [24] and lifestyle-integrated activity habits [11, 22]. Activities preferred by young seniors [25] such as walking, outdoor activities, household tasks, shopping, food/drink preparation, reading, or watching TV were considered for integrating exercises (online suppl.…”

“…Our systematic review suggests that the program has not been adapted to those aged 60–70 years [11]. Developing an adapted LiFE program seems highly relevant to tackle an accelerated, but preventable, functional decline at this age in those not meeting PA guidelines, not interested in formal training, and those with functional decline risk factors.…”

Interventions to Improve Gait in Older Adults with Cognitive Impairment: A Systematic Review

“…Our results indicate that combining strength and balance exercises with mobility training targeted on basic functions required during activities of daily living (functional mobility training) such as sit‐to‐stand, walking, navigating spaces, and turning may be effective in improving gait. Functional mobility training seemed to be one common element of successful programs, with better outcomes than physical programs with only static, resistance, and flexibility training, and there is evidence that functional and integrated exercise training can improve motor performance in older adults without dementia . Most activities of daily living, such as going to the toilet, answering the telephone, and preparing a meal, require the ability to walk.…”

“…Functional mobility training seemed to be one common element of successful programs, with better outcomes than physical programs with only static, resistance, and flexibility training, and there is evidence that functional and integrated exercise training can improve motor performance in older adults without dementia. 63 Most activities of daily living, such as going to the toilet, answering the telephone, and preparing a meal, require the ability to walk. Gait is the pattern of walking, and gait ability is directly relevant to level of functional activity.…”